Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients?

doi:10.4251/wjgo.v16.i4.1334

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World Journal of Gastrointestinal Oncology

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1948-5204

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

World J Gastrointest Oncol. Apr 15, 2024; 16(4): 1334-1343
Published online Apr 15, 2024. doi: 10.4251/wjgo.v16.i4.1334

Table 1 Baseline characteristics of included studies

Ref.	Country	Study date	Study type	Sample size		Years old		Age range	NOS
Ref.	Country	Study date	Study type	ERAS	Conventional	ERAS	Conventional	Age range	NOS
Xiao et al[17], 2022	China	2019-2021	Prospective	50	50	72.7 ± 2.7	72.3 ± 2.3	≥ 70	8
Franceschilli M et al[22], 2022	Italy	2013-2021	Retrospective	23	21	69.7 ± 9.8	64.3 ± 6.7	≥ 18	7
Weindelmayer et al[23], 2021	Italy	2015-2019	Retrospective	248	103	68	70	60-78	7
Cao S et al[24], 2021	China	2014-2018	Prospective	85	86	70.8 ± 3.4	71.4 ± 3.7	65-85	7
Liu et al[25], 2016	China	2014-2015	Retrospective	42	42	68.5 ± 4.5	69.5 ± 5.4	≥ 60	8
Bu et al[26], 2015	China	2010-2014	Retrospective	64	64	80.1 ± 4.0	79.6 ± 3.5	45-90	8

ERAS: Enhanced recovery after surgery; NOS: Newcastle-Ottawa Scales.

Table 2 Summary of characteristics between the enhanced recovery after surgery group and the conventional group

Characteristics	Studies	Participants (ERAS/conventional)	Odds ratio/mean difference (95%CI)	Heterogeneity
Age (yr)	5	264/263	0.06 (-0.18, 0.30); P = 0.65	I² = 46.03%; P = 0.12
Sex, female	6	512/366	0.95 (0.71, 1.26); P = 0.71	I² = 0.00%; P = 0.63
BMI (kg/m²)	5	264/263	-0.05 (-0.22, 0.12); P = 0.54	I² = 0.00%; P = 0.45
Smoking	2	333/189	1.00 (0.69, 1.44); P = 0.98	I² = 0.00%; P = 0.62
ASA, ≥2	4	222/221	1.03 (0.64, 1.64); P = 0.92	I² = 0.00%; P = 0.58
TNM stage
I	6	Reference	Reference	Reference
II	6	263/215	1.03 (0.69, 1.54); P = 0.88	I² = 0.00%; P = 0.81
III	6	399/293	0.89 (0.64, 1.23); P = 0.47	I² = 0.00%; P = 0.46
Type of surgery
Total	3	Reference	Reference	Reference
Distal	3	122/126	1.28 (0.74, 2.22); P = 0.38	I² = 0.00%; P = 0.97
Proximal	3	69/72	1.36 (0.62, 2.98); P = 0.44	I² = 0.00%; P = 0.38
Type of reconstruction
Roux-en-Y	2	Reference	Reference	Reference
Billroth-I	2	56/58	1.25 (0.59, 2.67); P = 0.56	I² = 0.00%; P = 0.40
Billroth-II	2	78/80	1.17 (0.62, 2.22); P = 0.63	I² = 0.00%; P = 0.92
Neoadjuvant chemotherapy	2	271/124	2.74 (1.64, 4.57); P = 0.00*	I² = 0.00%; P = 0.45
Comorbidities
Cardiovascular system disease	4	462/316	1.00 (0.72, 1.39); P = 1.00	I² = 0.00%; P = 0.86
Respiratory system diseases	4	462/316	1.04 (0.62, 1.73); P = 0.89	I² = 15.67%; P = 0.31
Renal system diseases	2	333/189	0.92 (0.47, 1.82); P = 0.82	I² = 0.00%; P = 0.57
Diabetes	4	462/316	0.73 (0.48, 1.12); P = 0.15	I² = 12.29%; P = 0.34

ASA: American Society of Anesthesiologists; TMN: Tumor Node Metastasis; 95%CI: 95% confidence intervals; ERAS: Enhanced recovery after surgery.

Table 3 Operative and postoperative complications between enhanced recovery after surgery group and conventional group

Characteristics	Studies	Participants (ERAS/conventional)	Odds ratio/mean difference (95%CI)	Heterogeneity
Operative time (min)	4	241/242	0.05 (-0.16, 0.26); P = 0.64	I² = 25.46%; P = 0.26
Postoperative hospital stays	10	179/177	-0.51 (-0.72, -0.30); P = 0.00^a	I² = 0.00%; P = 0.52
Operative blood loss (mL)	2	108/108	-0.09 (-0.36, 0.17); P = 0.49	I² = 0.00%; P = 0.41
Postoperative bleeding	2	108/107	0.47 (0.08, 2.23); P = 0.39	I² = 0.00%; P = 0.93
Time to first flatus(defecation)	4	129/127	-0.30 (-0.55, -0.06); P = 0.02^a	I² = 0.00%; P = 0.74
Anastomotic leakage	5	470/324	1.10 (0.40, 3.03); P = 0.86	I² = 0.00%; P = 0.59
Intestinal obstruction	3	156/156	3.24 (1.07, 9.78); P = 0.04^a	I² = 0.00%; P = 0.91
Pulmonary related complication	6	512/366	0.76 (0.43, 1.35); P = 0.35	I² = 0.00%; P = 0.87
Cardiovascular related complication	2	333/189	0.53 (0.25, 1.11); P = 0.09	I² = 0.00%; P = 0.93
Nausea and vomiting	2	106/106	4.07 (1.29, 12.84); P = 0.02^a	I² = 0.00%; P = 0.52
Gastric retention	2	106/106	5.69 (2.00, 16.20); P = 0.00^a	I² = 2.46%; P = 0.31
Urinary retention	2	106/106	0.68 (0.25, 1.88); P = 0.46	I² = 0.00%; P = 0.57
Incision infection	2	106/106	2.26 (0.49, 10.41); P = 0.30	I² = 0.00%; P = 0.83
Urinary tract infection	2	106/106	0.52 (0.18, 1.46); P = 0.21	I² = 0.00%; P = 0.86
Reoperation	3	356/210	0.46 (0.07, 3.00); P = 0.42	I² = 29.68%; P = 0.24
Readmission	5	470/324	1.42 (0.46, 4.33); P = 0.54	I² = 47.15%; P = 0.11

95%CI: 95% confidence intervals; ERAS: Enhanced recovery after surgery.

^aP < 0.05.

Citation: Li ZW, Luo XJ, Liu F, Liu XR, Shu XP, Tong Y, Lv Q, Liu XY, Zhang W, Peng D. Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients? World J Gastrointest Oncol 2024; 16(4): 1334-1343
URL: https://www.wjgnet.com/1948-5204/full/v16/i4/1334.htm
DOI: https://dx.doi.org/10.4251/wjgo.v16.i4.1334